Get Embassy of Ethiopia Power of Attorney Request Form

3506 INTERNATIONAL DR NW WASHINGTON DC 20008 TELE 202 364 1200 WKL m yqE QA EMBASSY OF ETHIOPIA CONSULAR OFFICE PASSPORT AND VISA SERVICES POWER OF ATTORNEY REQUEST FORM PLEASE TYPE OR PRINT YOUR ANSWER IN THE SPACE PROVIDED BELOW FAILURE TO PRINT CLEARLY MAY DELAY YOUR APPLICATION. X K lX N N WKL snD xN ND QA Y l PLEASE FILLOUT THIS FORM FOR EACH DOCUMENT. bWKL sn Y kxND b Y w Y l bQ Y ymjm W w Y tA l l c w C t w Y / l/ b lW sN ri Y mr WN Y l. IF THERE IS MORE THAN ONE PRINCIPAL PLEASE FILL THE SPACE UNDER THE TITLE FOR ADDITIONAL PRINCIPALS IF ANY 1 WKL ys W GlsB/DRJT mr /PRINCIPAL INFORMATION/ yw Y l SM / FOR AN INDIVIDUAL / 1. 1. TITLE/PREFIX 1. 2. FIRST NAME 1. 3. MIDDLE NAME 1. 5. NATIONALITY 1. 4. LAST NAME 1. 6. ETHIOPIAN PASSPORT /ETHIOPIAN ORIGIN ID NUMBER IF APPLICABLE WKL ys W bDRJT SM k n /FOR A COMPANY / 1. 7. COMPANY NAME 1. 8. CONTACT PERSON IF APPLICABLE DON NOT WRITE IN THIS SPACE FOR OFFICIAL USE ONLY /ADDRESS / 2. 1. ADDRESS STREET NUMBER NAME AND APT 2. 2. COUNTRY 2. 3. STATE SERVICE DATE 2. 4. CITY 2. 6. DAYTIME PHONE 2. 5. ZIP CODE REF* NUMBER 2. 7. EVENING PHONE FEE PAID 2. 8. E-MAIL RECEIPT NO 3 yx jNs mr WKL W bx jNs bk L km /AGENCY INFORMATION IF APPLICATION IS PRESENTED THROUGH AN AGENCY 3. 1. AGENCY NAME 4 t w Y / l/ FOR ADDITIONAL PRINCIPALS NO NAME 3. 3. TELEPHONE IF ANY ETHIOPIAN PASSPORT /ETHIOPIAN ORIGIN ID NUMBER IF APPLICABLE I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF* PREPARED NAME SIGNATURE DATE. bWKL sn Y kxND b Y w Y l bQ Y ymjm W w Y tA l l c w C t w Y / l/ b lW sN ri Y mr WN Y l. IF THERE IS MORE THAN ONE PRINCIPAL PLEASE FILL THE SPACE UNDER THE TITLE FOR ADDITIONAL PRINCIPALS IF ANY 1 WKL ys W GlsB/DRJT mr /PRINCIPAL INFORMATION/ yw Y l SM / FOR AN INDIVIDUAL / 1. 1. TITLE/PREFIX 1. 2. FIRST NAME 1. 3. MIDDLE NAME 1. 5. NATIONALITY 1. 4. LAST NAME 1. 6. ETHIOPIAN PASSPORT /ETHIOPIAN ORIGIN ID NUMBER IF APPLICABLE WKL ys W bDRJT SM k n /FOR A COMPANY / 1. 1. TITLE/PREFIX 1. 2. FIRST NAME 1. 3. MIDDLE NAME 1. 5. NATIONALITY 1. 4. LAST NAME 1. 6. ETHIOPIAN PASSPORT /ETHIOPIAN ORIGIN ID NUMBER IF APPLICABLE WKL ys W bDRJT SM k n /FOR A COMPANY / 1. 7. COMPANY NAME 1. 8. CONTACT PERSON IF APPLICABLE DON NOT WRITE IN THIS SPACE FOR OFFICIAL USE ONLY /ADDRESS / 2. 7. COMPANY NAME 1. 8. CONTACT PERSON IF APPLICABLE DON NOT WRITE IN THIS SPACE FOR OFFICIAL USE ONLY /ADDRESS / 2. 1. ADDRESS STREET NUMBER NAME AND APT 2. 2. COUNTRY 2. 3. STATE SERVICE DATE 2. 4. CITY 2. 6. DAYTIME PHONE 2. 1. ADDRESS STREET NUMBER NAME AND APT 2. 2. COUNTRY 2. 3. STATE SERVICE DATE 2. 4. CITY 2. 6. DAYTIME PHONE 2. 5. ZIP CODE REF* NUMBER 2. 7. EVENING PHONE FEE PAID 2. 8. E-MAIL RECEIPT NO 3 yx jNs mr WKL W bx jNs bk L km /AGENCY INFORMATION IF APPLICATION IS PRESENTED THROUGH AN AGENCY 3. 5. ZIP CODE REF* NUMBER 2. 7. EVENING PHONE FEE PAID 2. 8. E-MAIL RECEIPT NO 3 yx jNs mr WKL W bx jNs bk L km /AGENCY INFORMATION IF APPLICATION IS PRESENTED THROUGH AN AGENCY 3. 1. AGENCY NAME 4 t w Y / l/ FOR ADDITIONAL PRINCIPALS NO NAME 3. 3. TELEPHONE IF ANY ETHIOPIAN PASSPORT /ETHIOPIAN ORIGIN ID NUMBER IF APPLICABLE I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF* PREPARED NAME SIGNATURE DATE. .